1
|
Lai-Kwon J, Jefford M, Best S, Zhang I, Rutherford C. Selecting Immune Checkpoint Inhibitor Side Effects for Real-Time Monitoring in Routine Cancer Care: A Modified Delphi Study. JCO Oncol Pract 2024:OP2400037. [PMID: 39151111 DOI: 10.1200/op.24.00037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 06/21/2024] [Accepted: 07/17/2024] [Indexed: 08/18/2024] Open
Abstract
PURPOSE Electronic patient-reported outcome (ePRO) symptom monitoring may support the safe delivery of immune checkpoint inhibitors (ICI). There is no consensus on which side effects should be monitored in routine care. We aimed to develop a prioritized list of ICI side effects to include in ePRO systems and compare this to existing ICI-specific patient-reported outcome measures (PROMs). METHODS We conducted a two-round modified Delphi survey. Participants were patients (or their carers) who had received/were receiving ICI or managing health care professionals (HCPs). Round 1 (R1) side effects were generated from a literature review and existing PROMs. In R1, participants rated the importance of 63 ICI side effects in an ePRO system on a five-point Likert scale. In round 2 (R2), participants ranked the 10 most important side effects from 36 side effects. Content mapping of the prioritized list against existing PROMs was conducted. RESULTS In R1, 47 patients, nine carers, and 58 HCPs responded. Twenty-eight side effects were rated important (I)/very important (VI) by >75% of participants and included in R2. Ten were rated I/VI by <50% of participants and excluded. Twenty-five were rated I/VI by 50%-75% of participants and discussed at an HCP roundtable to determine inclusion in R2. In R2, 39 patients, 11 carers, and 42 HCPs ranked seizures, shortness of breath, chest pain, diarrhea, and rash as the most important side effects for monitoring. Content mapping showed significant differences between the prioritized list and existing PROMs. CONCLUSION We developed a consumer- and clinician-driven prioritized list of 36 ICI side effects to include in future ePRO systems. This process highlights the importance of broad stakeholder engagement in side-effect selection and rigorously identifying clinically important side effects to ensure content validity and clinical utility.
Collapse
Affiliation(s)
- Julia Lai-Kwon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Michael Jefford
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Stephanie Best
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
- Victorian Comprehensive Cancer Centre Alliance, Melbourne, VIC, Australia
- Australian Genomics, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Iris Zhang
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Claudia Rutherford
- Sydney Quality of Life Office, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
2
|
AlQuzi F, Bowers A, Alexander K, Bradford N. Assessment of Symptoms and Adverse Events Related to Immunotherapy in Patients With Cancer: An Integrative Review. J Pain Symptom Manage 2023; 66:e69-e84. [PMID: 36858244 DOI: 10.1016/j.jpainsymman.2023.02.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/12/2023] [Accepted: 02/15/2023] [Indexed: 03/03/2023]
Abstract
CONTEXT Clinical practice guidelines advocate for routine assessment of symptoms and adverse events during immunotherapy treatment of cancer. Outside the clinical trial setting, there are few examples of such assessment in practice. OBJECTIVES To identify, appraise, and synthesize the available literature regarding the assessment of immune-related symptoms and adverse events in patients with cancer beyond the clinical trial setting. Specifically, we aimed to identify the measurement instruments used, who completes these and when. METHODS We completed an integrative review following established methods including a systematic literature search of electronic databases, a dual process for screening, quality appraisal, and data extraction. We included primary studies (retrospective or prospective) reporting the use of instruments or strategies to assess symptoms or adverse events in patients with cancer treated with immunotherapy. Outcomes of interest included: 1) how immune-related symptoms and adverse events were assessed; 2) types of assessment instruments; 3) frequency of instrument use and mode of administration; 4) the reported duration and intensity of symptoms and 5) adverse events and associated management strategies. Data were synthesized narratively. RESULTS We screened 2138 articles and included 16 articles representing 2553 patients with cancer undergoing immunotherapy. All articles were published between 2018 and 2022 and were of sound methodological quality. Seven studies were retrospective chart reviews, and the remaining studies prospectively collected data, with seven collecting patient reported outcomes. In studies where data were collected at more than one time point (n = 6), weekly assessment during immunotherapy was the most common frequency. The potential for implementation of assessment into routine clinical practice was described in just four studies. CONCLUSION Despite recommendations from clinical practice guidelines for routine assessment of symptoms and adverse events during immunotherapy treatment for cancer, there are few examples of how this is undertaken in clinical practice. The use of patient reported outcome measures to assess toxicity from immunotherapy is uncommon but offers the potential to identify symptoms early and facilitate timely intervention. Our review highlights the available instruments, how they have been used and the need for more applied research in this field to optimize patient outcomes.
Collapse
Affiliation(s)
- Fatimah AlQuzi
- School of Nursing (F.A., A.B., K.A., N.A.), Queensland University of Technology, Kelvin Grove, Australia; School of Nursing (F.A.), Umm AL-Qura University, Mecca, Kingdom of Saudi Arabia
| | - Alison Bowers
- School of Nursing (F.A., A.B., K.A., N.A.), Queensland University of Technology, Kelvin Grove, Australia; Cancer and Palliative Care Outcomes Centre for Children's Health Research (A.B., K.A., N.B.), Queensland University of Technology, South Brisbane, Australia
| | - Kimberley Alexander
- School of Nursing (F.A., A.B., K.A., N.A.), Queensland University of Technology, Kelvin Grove, Australia; Cancer and Palliative Care Outcomes Centre for Children's Health Research (A.B., K.A., N.B.), Queensland University of Technology, South Brisbane, Australia
| | - Natalie Bradford
- School of Nursing (F.A., A.B., K.A., N.A.), Queensland University of Technology, Kelvin Grove, Australia; Cancer and Palliative Care Outcomes Centre for Children's Health Research (A.B., K.A., N.B.), Queensland University of Technology, South Brisbane, Australia.
| |
Collapse
|
3
|
Wu X, Xie J, Lin X, Hua L, Ding P, Liu S, Shi S. Translation and validation of chinese version of MDASI immunotherapy for early-phase trials module: a cross-sectional study. BMC Nurs 2023; 22:176. [PMID: 37217922 DOI: 10.1186/s12912-023-01217-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/21/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND During immunotherapy treatment and survival, identifying symptoms requires a standardized and validated assessment tool. The aim of this study was to translate, validate and use the Chinese version of the Immunotherapy of the M.D. Anderson Symptom Inventory for Early-Phase Trials module (MDASI-Immunotherapy EPT) to assess the symptom burden of cancer patients receiving immunotherapy in China. METHODS The MDASI-Immunotherapy EPT was translated into Chinese using Brislin's translation model and the back-translation method. In total, 312 Chinese-speaking colorectal cancer patients receiving immunotherapy were enrolled in the trial from August 2021 to July 2022 after receiving definitive diagnoses in our cancer center. The reliability and validity of the translated version was evaluated. RESULTS Cronbach's α values were 0.964 and 0.935 for the symptom severity and interference scales, respectively. Significant correlations were found between the MDASI-Immunotherapy EPT-C and FACT-G scores (-0.617-0.732, P < 0.001). Known-group validity was supported by significant differences in the scores of the four scales grouped by ECOG PS (all P < 0.01). The overall mean subscale scores for the core and interference subscales were 1.92 ± 1.75 and 1.46 ± 1.87, respectively. Fatigue, numbness/tingling, and disturbed sleep had the highest scores for the most serious symptoms. CONCLUSION The MDASI-Immunotherapy EPT-C showed adequate reliability and validity for measuring symptoms among Chinese-speaking colorectal cancer patients receiving immunotherapy. The tool could be used in clinical practice and clinical trials to gather patients' health and quality of life data and manage their symptoms in a timely manner in the future.
Collapse
Affiliation(s)
- Xiaodan Wu
- Sun Yat-sen University Cancer Center, Guangzhou, Guangdong Province, China
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, SAR, China
| | - Jingyue Xie
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Xiumei Lin
- Sun Yat-sen University Cancer Center, Guangzhou, Guangdong Province, China
| | - Limei Hua
- Sun Yat-sen University Cancer Center, Guangzhou, Guangdong Province, China
| | - Peirong Ding
- Sun Yat-sen University Cancer Center, Guangzhou, Guangdong Province, China.
| | - Shuyue Liu
- Sun Yat-sen University Cancer Center, Guangzhou, Guangdong Province, China.
| | - Simei Shi
- Sun Yat-sen University Cancer Center, Guangzhou, Guangdong Province, China.
| |
Collapse
|
4
|
Lai-Kwon J, Cohen JE, Lisy K, Rutherford C, Girgis A, Basch E, Jefford M. The Feasibility, Acceptability, and Effectiveness of Electronic Patient-Reported Outcome Symptom Monitoring for Immune Checkpoint Inhibitor Toxicities: A Systematic Review. JCO Clin Cancer Inform 2023; 7:e2200185. [PMID: 37220322 DOI: 10.1200/cci.22.00185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/07/2023] [Accepted: 03/30/2023] [Indexed: 05/25/2023] Open
Abstract
PURPOSE Increasing use of immune checkpoint inhibitors (ICIs) in routine cancer care will increase the incidence of immune-related adverse events (irAEs). Systems are needed to support remote monitoring for irAEs. Electronic patient-reported outcome (ePRO) symptom monitoring systems can help monitor and manage symptoms and side effects. We assessed the content and features of ePRO symptom monitoring systems for irAEs, and their feasibility, acceptability, and impact on patient outcomes and health care utilization. METHODS A systematic literature search was conducted in May 2022 on MEDLINE, Embase, PsycINFO, and Cochrane Central Register of Controlled Trials. Quantitative and qualitative data relevant to the review questions were extracted and synthesized in tables. RESULTS Seven papers describing five ePRO systems were included. All systems collected PROs between clinic visits. Two of five used validated symptom questionnaires, 3/5 provided prompts to complete questionnaires, 4/5 provided reminders to self-report, and 3/5 provided clinician alerts for severe/worsening side effects. Four of five provided coverage of ≥26/30 irAEs in the ASCO irAE guideline. Feasibility and acceptability were demonstrated with consent rates of 54%-100%, 17%-27% of questionnaires generating alerts, and adherence rates of 74%-75%. One paper showed a reduction in grade 3-4 irAEs, treatment discontinuation, clinic visit duration, and emergency department presentations, while another showed no difference in these outcomes or the rate of steroid use. CONCLUSION There is preliminary evidence of the feasibility and acceptability of ePRO symptom monitoring for irAEs. However, further studies are needed to confirm the impact on ICI-specific outcomes, such as the frequency of grade 3-4 irAEs and duration of immunosuppression. Suggestions for the content and features of future ePRO systems for irAEs are provided.
Collapse
Affiliation(s)
- Julia Lai-Kwon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Jordan E Cohen
- Liverpool Hospital, South-Western Sydney Local Health District, Sydney, NSW, Australia
| | - Karolina Lisy
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Claudia Rutherford
- Sydney Quality of Life Office, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
- Cancer Care Research Unit (CCRU), Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Afaf Girgis
- South-West Sydney Clinical Campuses, University of New South Wales Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Ethan Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Michael Jefford
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
5
|
Zhang J, Wang S, Zhou Z, Lei C, Yu H, Zeng C, Xia X, Qiao G, Shi Q. Unpleasant symptoms of immunotherapy for people with lung cancer: A mixed-method study. Int J Nurs Stud 2023; 139:104430. [PMID: 36638590 DOI: 10.1016/j.ijnurstu.2022.104430] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Immunotherapy has changed the outlook for lung cancer treatment. A closer look at the accompanying symptoms from the patient's perspective is necessary to improve their tolerance to the treatment, which is also the basis for standardized symptom management. OBJECTIVE To describe the symptomatic experiences of patients receiving immunotherapy for lung cancer and explore whether symptoms reported during immunotherapy were associated with survival outcomes. DESIGN Exploratory sequential mixed-method study. SETTINGS Patients were continuously recruited from the oncology day ward of Guangdong Provincial People's Hospital between October 2019 and January 2020. PARTICIPANTS 59 patients with advanced lung cancer and receiving immunotherapy (median [IQR] age was 64 [58-69]; 72.9 % pathological stage was IV) were included in the study. METHODS A sequential qualitative interview on symptom experiences was conducted from the perspective of lung cancer patients in immunotherapy. Summative content analysis was used to develop a standardized symptom reporting checklist. Survival outcome follow-ups of each patient were conducted 2 years after the interview. RESULTS 47 symptoms were extracted from the 124 interviews of 59 patients, the common symptoms including musculoskeletal pain (52.5 %), itchy skin (45.8 %), fatigue (45.8 %), cough (44.1 %), shortness of breath (32.2 %), lack of appetite (32.2 %), and rashes (32.2 %). The timing, severity, and interference of symptoms were different among patients. The symptoms of shortness of breath, fatigue and chest pain were more common in chemo-immunotherapy, while dry mouth and blurred vision were more frequent with immunotherapy. The symptoms of musculoskeletal pain, shortness of breath, lack of appetite, drowsiness and taste change were more common for those who died two years after the interviews; for those who survived, the symptoms of rash and chill were more common. CONCLUSIONS We generated a symptom list related to lung cancer immunotherapy from the patients, provided a closer look at symptoms from the patient's perspective, and suggested differences in the presence of symptoms between the group of treatment and survival outcome. This enables clinicians and nurses to better understand and empathize with the patient's experience, so as to truly practice the essence of patient-centered care, and provide a basis for the development of standardized symptom measurement tools in the future. TWEETABLE ABSTRACT At least 47 unpleasant symptoms were present in immunotherapy from the perspective of lung cancer patients.
Collapse
Affiliation(s)
- Jingyu Zhang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Sichao Wang
- Department of Thoracic Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; Department of Clinical Oncology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Zihao Zhou
- Department of Thoracic Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Cheng Lei
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Hongfan Yu
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Cheng Zeng
- Department of Thoracic Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xin Xia
- Department of Thoracic Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guibing Qiao
- Department of Thoracic Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
| | - Qiuling Shi
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China; School of Public Health, Chongqing Medical University, Chongqing, China.
| |
Collapse
|
6
|
Mendoza TR, Hong DS, Peterson CB, Stephen B, Dumbrava E, Pant S, Tsimberidou AM, Yap TA, Sheshadri A, Altan M, George G, Castillo L, Rodriguez E, Gong J, Subbiah V, Janku F, Fu S, Piha-Paul SA, Ahnert JR, Karp DD, Cleeland C, Meric-Bernstam F, Naing A. Patient-reported symptom burden in patients with rare cancers receiving pembrolizumab in a phase II Clinical Trial. Sci Rep 2022; 12:14367. [PMID: 35999229 PMCID: PMC9399082 DOI: 10.1038/s41598-022-16588-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 07/12/2022] [Indexed: 11/12/2022] Open
Abstract
Patients with rare solid tumors treated on early phase trials experience toxicities from their tumors and treatments. However, limited data exist to describe the detailed symptom burden suffered by these patients, particularly those with rare solid tumors treated with immunotherapy. We performed a prospective longitudinal study to capture patient-reported symptom burden. Patients completed the validated MD Anderson Symptom Inventory (MDASI)—Immunotherapy with 20 symptoms including 7 immunotherapy-specific items and 6 interference items at baseline and weekly thereafter for up to 9 weeks. Symptoms and interference were rated on 0–10 scales (0 = none or no interference, 10 = worst imaginable or complete interference). Group-based trajectory modelling determined higher and lower symptom groups. A total of 336 MDASI questionnaires were completed by 53 patients (mean age 55.4y, 53% male) with advanced rare cancers receiving pembrolizumab in a Phase II clinical trial. Symptoms reported as most severe over the course of the treatment over 9 weeks were fatigue [mean (M) = 3.8, SD = 2.3], pain (M = 3.7, SD = 2.9), disturbed sleep (M = 2.7, SD = 2.3), drowsiness (M = 2.6, SD = 2.0) and lack of appetite (M = 2.5, SD = 2.1). Pain in the abdomen (M = 2.2, SD = 2.4), rash (M = 1.1, SD = 1.8) and diarrhea (M = 0.9, SD = 1.5) were less severe. Interference with walking was rated the highest (M = 3.4, SD = 2.8) and relations with others was rated the lowest (M = 2.1, SD = 2.6). Using a composite score based on the five most severe symptoms (fatigue, pain, lack of appetite, feeling drowsy and sleep disturbance), 43% were classified into the high symptom burden group. Using a score based on immunotherapy-specific symptoms (e.g., rash, diarrhea) 33% of patients were included in the high symptom group. Symptom burden stayed relatively stable in the high- and low-symptom burden patient groups from baseline through 9 weeks. Some patients with rare malignancies experienced high symptom burden even at baseline. In patients with rare cancers, symptom trajectories stayed relatively stable over nine weeks of treatment with pembrolizumab. Trial registration: ClinicalTrials.gov identifier: NCT02721732.
Collapse
Affiliation(s)
- Tito R Mendoza
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - David S Hong
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christine B Peterson
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bettzy Stephen
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ecaterina Dumbrava
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shubbam Pant
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Apostolia Maria Tsimberidou
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Timothy Anthony Yap
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ajay Sheshadri
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mehmet Altan
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Goldy George
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lilibeth Castillo
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Enedelia Rodriguez
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jing Gong
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vivek Subbiah
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Filip Janku
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Siqing Fu
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sarina A Piha-Paul
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jordi Rodon Ahnert
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Daniel D Karp
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Charles Cleeland
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Funda Meric-Bernstam
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Aung Naing
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
7
|
Neurologic Toxicities of Immunotherapy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1342:417-429. [PMID: 34972978 DOI: 10.1007/978-3-030-79308-1_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Immunotherapy has revolutionized treatment of cancer over the past two decades. The antitumor effects of immunotherapy approaches are at the expense of growing spectrum of immune-related adverse events (irAEs) due to cross-reactivity between the tumor and normal host tissue. These adverse events can happen in any organ and range from mild to severe and even life-threatening conditions. While neurological irAEs associated with immune checkpoint inhibitors (CPIs) are rare, they pose a significant challenge in management as the clinical phenotypes are heterogenous and frequently necessitate cessation of therapy and systemic immune suppression and lead to transient functional decline. On the other hand, immune effector cell-associated neurotoxicity (ICANS) is common, frequently occurs in conjunction with cytokine release syndrome (CRS), and poses a significant clinical challenge to the development and widespread use of these effective therapies. Early recognition of these neurological syndromes, timely diagnosis, and thoughtful management are key for further clinical development of these effective therapies in cancer patients. Here, we describe clinical phenotypes of CPI-induced neurological complications and ICANS and discuss steps in clinical monitoring, diagnosis, and effective management.
Collapse
|
8
|
Hernando-Calvo A, Cescon DW, Bedard PL. Novel classes of immunotherapy for breast cancer. Breast Cancer Res Treat 2021; 191:15-29. [PMID: 34623509 DOI: 10.1007/s10549-021-06405-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 09/28/2021] [Indexed: 10/20/2022]
Abstract
Immune-checkpoint inhibitors have profoundly changed the treatment landscape for many tumor types. Despite marked improvements in disease control for highly immunogenic cancers, the clinical impact of checkpoint inhibitors in breast cancers to date is limited. Breast cancer is a heterogeneous disease with different levels of PD-L1 expression and variable tumor microenvironment (TME) composition according to molecular subtype. With emerging evidence of the role of different factors involved in immune evasion, there are promising new immunotherapy targets that will reshape early drug development for metastatic breast cancer. This review examines the available evidence for existing and emerging immuno-oncology (IO) approaches including small molecules targeting different regulators of the cancer-immunity cycle.
Collapse
Affiliation(s)
- Alberto Hernando-Calvo
- Division of Medical Oncology & Hematology, Department of Medicine, Princess Margaret Cancer Centre - University Health Network, University of Toronto, Toronto, Canada.
| | - David W Cescon
- Division of Medical Oncology & Hematology, Department of Medicine, Princess Margaret Cancer Centre - University Health Network, University of Toronto, Toronto, Canada
| | - Philippe L Bedard
- Division of Medical Oncology & Hematology, Department of Medicine, Princess Margaret Cancer Centre - University Health Network, University of Toronto, Toronto, Canada
| |
Collapse
|
9
|
Galindo Vázquez O, Aguilar González CN, Meneses García A, Calderillo Ruiz G, Bargalló Rocha E, Herrera Gómez Á. Validación del cuestionario básico de síntomas M. D. Anderson (MDASI) para pacientes con cáncer en población mexicana. PSICOONCOLOGIA 2021. [DOI: 10.5209/psic.77757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introducción: Los diferentes síntomas en el paciente con cáncer pueden afectar las actividades en la vida cotidiana, las decisiones terapéuticas, así como la calidad de vida. Por lo que identificar la sintomatología en este grupo de pacientes es de suma importancia. Objetivo: Validar el cuestionario básico de síntomas M. D. Anderson (MDASI) para pacientes con cáncer en población mexicana. Método: Se incluyeron 309 pacientes del Instituto Nacional de Cancerología con edad entre 18 a 85 años, el tipo de estudio fue transversal, no experimental. Instrumentos: Cuestionario básico de síntomas MDASI, Cuestionario de Calidad de Vida de la Organización Europea para el tratamiento e Investigación del cáncer (EORTC-QLQ-C30) y Termómetro de Distrés. Resultados: Un análisis factorial ajustado a dos factores presentó un instrumento con 12 reactivos, similar a la versión original. La consistencia interna de la escala global mostró un índice satisfactorio (0,86). Las alfas de Cronbach de cada subescala tuvieron un valor de 0,79 y 0,80 que explicaron el 48,04% de la varianza global. La validez, por medio de correlación con las medidas concurrentes, mostró resultados significativos (r de Pearson de 0,954 a -0,267, p<0,01). Conclusiones: El instrumento MDASI mostro propiedades psicométricas adecuadas, similar a la versión original. Es útil para la práctica clínica e investigación. Se recomienda realizar estudios complementarios para determinar su sensibilidad en efectos de intervenciones médicas y psicológicas.
Collapse
|
10
|
Associations between the gut microbiome and fatigue in cancer patients. Sci Rep 2021; 11:5847. [PMID: 33712647 PMCID: PMC7954807 DOI: 10.1038/s41598-021-84783-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 02/18/2021] [Indexed: 12/17/2022] Open
Abstract
Fatigue is the most prevalent symptom of cancer and its treatments. Changes in the intestinal microbiome have been identified in chronic fatigue syndrome and other neuropsychiatric disorders, and cancer patients. However, the association between intestinal microbiome and fatigue in patients with advanced cancers has not been evaluated. Understanding the connection between intestinal microbiome and fatigue will provide interventional and therapeutic opportunities to manipulate the microbiome to improve fatigue and other patients’ reported outcomes. In this project, we aimed to identify associations between microbiome composition and fatigue in advanced cancer patients. In this cross-sectional observational study at a tertiary cancer care center, we included 88 patients with advanced, metastatic, unresectable cancers who were in a washout period from chemotherapy. We measured fatigue using the MD Anderson Symptom Inventory—Immunotherapy fatigue score, and used 16srRNA to analyze intestinal microbiome. Using correlation analysis we found that Eubacterium hallii was negatively associated with fatigue severity scores (r = − 0.30, p = 0.005), whereas Cosenzaea was positively associated with fatigue scores (r = 0.33, p = 0.0002). We identified microbial species that exhibit distinct composition between high-fatigued and low-fatigued cancer patients. Further studies are warranted to investigate whether modulating the microbiome reduces cancer patients’ fatigue severity and improves their quality of life.
Collapse
|
11
|
Naing A, Hajjar J, Gulley JL, Atkins MB, Ciliberto G, Meric-Bernstam F, Hwu P. Strategies for improving the management of immune-related adverse events. J Immunother Cancer 2020; 8:e001754. [PMID: 33310772 PMCID: PMC7735083 DOI: 10.1136/jitc-2020-001754] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 02/07/2023] Open
Abstract
With the advent of immunotherapeutic agents, durable and dramatic responses have been observed in several hard-to-treat malignancies, outlining a roadmap to conquering cancer. Immune checkpoint inhibitors (ICPi) are a class of immunotherapeutic agents that attack the tumor cells by reinvigorating the suppressed immune system. However, the unbridled T-cell activity disrupts the immune homeostasis and induces a unique spectrum of side effects called immune-related adverse events (irAEs) in a significant proportion of patients. These irAEs are distinct from the side effects produced by traditional chemotherapeutic agents. Although majority of irAEs are manageable with corticosteroids and other immunosuppressive agents, life-threatening and fatal events have been reported. In the absence of predictive biomarkers to identify patients at risk for irAEs and standardized approach to detect, report, and treat irAEs, management of irAEs has been challenging to the patients, caregivers and the healthcare providers alike. With increasing use of ICPis for treatment of various cancers, the incidence of irAEs will undoubtedly increase. There is a compelling need to develop measures to effectively manage irAEs, both in the community settings and in cancer centers alike. To this end, in this paper, we propose several strategies, such as providing patient education, harmonizing irAE management guidelines, standardizing reporting of irAEs, optimizing the choice of immunosuppressive agents, conducting preclinical, clinical and translational studies to better understand irAEs, including high-risk patients, incorporating diagnostic tools to personalize irAE management using wireless technology and digital health, providing a platform to hear the missing patient's voice, and sharing evolving data to improve the management of irAEs.
Collapse
Affiliation(s)
- Aung Naing
- Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Joud Hajjar
- William T Shearer Center for Human Immunobiology, Section of Immunology, Allergy and Retrovirology, Baylor College of Medicine, Houston, Texas, USA
| | - James L Gulley
- NCI, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Gennaro Ciliberto
- Scientific Directorate, Istituti Fisioterapici Ospedalieri, Roma, Italy
| | - Funda Meric-Bernstam
- Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Patrick Hwu
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|